Quantitative Laryngeal Electromyography Parameters May Correlate With Improved Outcomes Following Botulinum Toxin Injection For Spasmodic Dysphonia

Background Despite use of qualitative laryngeal electromyography (LEMG) guided botulinum toxin A (BoNT-A) injection for treatment of adductor spasmodic dysphonia (AdSD), unsatisfactory injections and complete "misses" remain problematic. We aimed to determine if the quantitative LEMG measure of number of small segments (NSS) correlates with voice outcomes following (BoNT-A injection for AdSD.Methods Automated quantitative LEMG analysis was performed during electromyography (EMG) -guided BoNT-A injection into the thyroarytenoid-lateral cricoarytenoid muscle complex for treatment of AdSD. Pre-injection phonatory NSS values were correlated with clinical voice outcomes and patient reported injection results.Results Quantitative LEMG measures were obtained for 45 AdSD patients (28 female, mean age 60.8 +/- 12.8 years) during EMG-guided BoNT-A injection. Mean sampled NSS during phonation immediately prior to BoNT-A injection was 524 +/- 323 (range: 2-904). Mean follow up was 36.5 +/- 9.4 days; one patient was lost to follow-up. In comparison to their previous BoNT-A injection, the current injection was rated as worse, same, and better by 13 (29.5%), 25 (56.8%), and 6 (13.6%) patients, respectively. All 4 (9.1%) patients with NSS < 200 rated their BoNT-A injection result as worse than previous, and change in Voice Handicap Index-10 (VHI-10) scores were worse or without change.Conclusions Aiming for an NSS value greater than 200 during phonation prior to BoNT-A toxin injection for AdSD may reduce unfavorable voice outcomes.